MEDICARE: THE ROYAL STICH BY MELINDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1124645882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ROYAL STICH BY MELINDA

Provider Business Mailing Address
First Line	:	8032 BLACK FOREST LN APT 10103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6746
Country	:	US
Telephone Number	:	203-710-9880
Fax Number	:	203-710-9880

Provider Business Practice Location Address
First Line	:	8032 BLACK FOREST LN APT 10103
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6746
Country	:	US
Telephone Number	:	203-710-9880
Fax Number	:	203-710-9880

Authorized Official
Title or Position	:	OWNER
Name	:	MELINDA COOPER
Credential	:
Telephone Number	:	203-710-9880

Provider Enumeration Date	:	06/29/2020
Last Update Date	:	06/29/2020

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Directions to “THE ROYAL STICH BY MELINDA ” Practice Location

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